Lai F, Kwan T L, Yuen W C, Wai A, Siu Y C, Shung E
Statistics and Research Unit, Head Office, Hong Kong, China.
Br J Surg. 2007 Sep;94(9):1172-8. doi: 10.1002/bjs.5793.
The aim of the study was to validate the use of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM), Portsmouth (P) POSSUM and upper gastrointestinal (O) POSSUM models in patients undergoing elective thoracic oesophagectomy for carcinoma.
The observed in-hospital mortality rates in 545 patients undergoing elective thoracic oesophagectomy for squamous cell carcinoma of the oesophagus in all public hospitals in Hong Kong was compared with rates predicted by POSSUM, P-POSSUM and O-POSSUM. The discriminatory power of these models was assessed using receiver-operator characteristic (ROC) curve analysis.
The observed mortality rate was 5.5 per cent, whereas rates predicted by POSSUM, P-POSSUM and O-POSSUM were 15.0, 4.7 and 10.9 per cent respectively. P-POSSUM showed no lack of fit (P = 0.814), but POSSUM (P < 0.001) and O-POSSUM (P = 0.002) showed lack of fit against observed mortality. POSSUM overpredicted mortality across nearly all risk groups, whereas O-POSSUM overpredicted mortality in patients with low physiological scores and in older patients. POSSUM (area under ROC curve 0.776) and P-POSSUM (0.776) showed equally good discriminatory power but O-POSSUM (0.676) was inferior.
P-POSSUM provided the most accurate prediction of in-hospital mortality in this group of patients who had elective oesophagectomy.
本研究旨在验证生理与手术严重程度评分系统（用于死亡率和发病率计算，POSSUM）、朴茨茅斯（P）POSSUM以及上消化道（O）POSSUM模型在接受食管癌择期胸段食管切除术患者中的应用。
将香港所有公立医院中545例因食管鳞状细胞癌接受择期胸段食管切除术患者的住院观察死亡率，与POSSUM、P-POSSUM和O-POSSUM预测的死亡率进行比较。使用受试者工作特征（ROC）曲线分析评估这些模型的辨别能力。
观察到的死亡率为5.5%，而POSSUM、P-POSSUM和O-POSSUM预测的死亡率分别为15.0%、4.7%和10.9%。P-POSSUM未显示拟合不足（P = 0.814），但POSSUM（P < 0.001）和O-POSSUM（P = 0.002）与观察到的死亡率相比显示出拟合不足。POSSUM在几乎所有风险组中都高估了死亡率，而O-POSSUM在生理评分低的患者和老年患者中高估了死亡率。POSSUM（ROC曲线下面积0.776）和P-POSSUM（0.776）显示出同样良好的辨别能力，但O-POSSUM（0.676）较差。
P-POSSUM对这组接受择期食管切除术的患者的住院死亡率提供了最准确的预测。
